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Previously,six measures were developed for a better collaboration of general practitioners and nurses in nursing homes in a qualitative multistep bottom-up process. These measures, summarised as the interprof ACT intervention, shall improve the flow of information and the communication between the involved parties and lead to more transparency and effectiveness regarding treatment decisions of nursing home residents.The major aim of this trial is to examine the clinical effectiveness of interprof ACT. The main hypothesis is that implementation of interprof ACT reduces the cumulative incidence of hospitalisations of nursing home residents within 12 months from 50% to 35% (15% absolute reduction).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control Group | No Intervention | Care of nursing home residents as usual. | |
| Interventional Group | Experimental | Implementation of interprof ACT measures to improve collaboration and communication between general practitioners and nursing staff. Measures are selected and adapted by nursing home management / nurses, GPs and residents' relatives or representatives. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| interprof ACT measures | Procedure | Definition of common goals between general practitioner and nursing staff, appointment of a contact person, support in assigning medication, use of name badges worn by GPs and nurses during visits, mandatory availability of contact person, standardized procedures for GPs home visits |
| Measure | Description | Time Frame |
|---|---|---|
| cumulative number of hospitalisation | Cumulative incidence of hospitalisations from nursing home residents within 12 months | within 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| absolute number of hospitalisations | number of hospitalisations within 12 months | within 12 months |
| hospital days | Hospital days within 12 months |
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Inclusion Criteria Residents:
Inclusion Criteria Nursing Homes:
Exclusion Criteria Residents:
- admission for short term care only
Exclusion Criteria Nursing Homes:
- participation in other projects on interprofessional collaboration.
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| Name | Affiliation | Role |
|---|---|---|
| Eva Hummers, Prof. Dr. med. | Department of General Practice, University Medical Center Goettingen | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of General Practice, University Medical Center Göttingen | Göttingen | Germany | ||||
| Organization and Corporate Development, Georg August University Göttingen |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41795085 | Derived | Luth F, Weber CE, Kortkamp C, Steyer L, Muller CA, Tetzlaff B, Mazur AL, Kuhn A, Scherer M, Kopke S, Friede T, Hummers E, Maurer I, Balzer K. Implementation of a complex intervention to improve interprofessional collaboration in long-term care: results of the mixed-methods process evaluation within the interprof ACT trial. BMC Health Serv Res. 2026 Mar 7;26(1):484. doi: 10.1186/s12913-026-14270-2. | |
| 36934341 |
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Blinded study nurses with respect of primary outcome.
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|
| within 12 months |
| mortality | mortality within 12 months | within 12 months |
| potentially inadequate medications | potentially inadequate medications at baseline and for follow-ups at 6 and 12 months | baseline and after 6 and 12 months |
| Adverse Events | Adverse Events within 12 months | within 12 months |
| Quality of Life in Alzheimer's Disease scale - Nursing Home version (QoL-AD-NH) | Residents' quality of life at baseline and at 12 months. Scale range is 15 - 60, with higher scores indicating higher QoL. | baseline and after 12 months |
| Health-related Quality of Life (HRQL) of residents measured by EQ-5D-5L | The EQ-5D-5L consist of two self-rating components: the EQ-5D descriptive system and a visual analogue scale (EQ VAS). The EQ-5D descriptive system measures HRQL on the five dimensions "mobility", "self-care", "usual activities", "pain / discomfort" and "anxiety / depression". On each dimension participants can rate either "no problems" (0), "slight problems" (1), "moderate problems" (2), "severe problems" (3) or "extreme problems" (4), resulting in a score ranging from 0 (best) to 4 (worst). The scores of the single dimensions can be combined to a sum score ranging from 0 (best) to 20 (worst). In addition, so called "utility weights" can be attached to any possible combination of answers on the EQ-5D descriptive system which results in a utility score ranging from 0 (death) to 1 (full HRQL), which is then used to calculate quality-adjusted life years (QALYs). The EQ VAS ranges from 0 (worst imaginable health state) to 100 (best imaginable health state). | baseline and after 12 months |
| medical services | use of other medical services within 12 months | within 12 months |
| economic evaluation: efficiency | economic evaluation: efficiency (incremental cost-effectiveness ratio) and cost savings from payer and societal perspective | after 12 months |
| Quality of inter-professional collaboration according to the Partnership Self-Assessment Tool (PSAT) score | Higher score values indicating better collaboration. | after 12 months |
| Attitudes towards inter-professional collaboration according to the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSAPNC) score | Higher score values indicating more favourable attitudes. | after 12 months |
| Göttingen |
| Germany |
| Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf | Hamburg | Germany |
| Institute for Social Medicine and Epidemiology, Nursing Research Group,University of Lübeck | Lübeck | Germany |
| Derived |
| Mazur A, Tetzlaff B, Mallon T, Hesjedal-Streller B, Wei V, Scherer M, Kopke S, Balzer K, Steyer L, Friede T, Pfeiffer S, Hummers E, Muller C. Cluster randomised trial of a complex interprofessional intervention (interprof ACT) to reduce hospital admission of nursing home residents. Age Ageing. 2023 Mar 1;52(3):afad022. doi: 10.1093/ageing/afad022. |
| 35804455 | Derived | Steyer L, Kortkamp C, Muller C, Tetzlaff B, Fleischmann N, Weber CE, Scherer M, Kuhn A, Jarchow AM, Luth F, Kopke S, Friede T, Konig HH, Hummers E, Maurer I, Balzer K. Implementation, mechanisms of change and contextual factors of a complex intervention to improve interprofessional collaboration and the quality of medical care for nursing home residents: study protocol of the process evaluation of the interprof ACT intervention package. Trials. 2022 Jul 8;23(1):561. doi: 10.1186/s13063-022-06476-6. |
| 33153484 | Derived | Muller C, Hesjedal-Streller B, Fleischmann N, Tetzlaff B, Mallon T, Scherer M, Kopke S, Balzer K, Gartner L, Maurer I, Friede T, Konig HH, Hummers E. Effects of strategies to improve general practitioner-nurse collaboration and communication in regard to hospital admissions of nursing home residents (interprof ACT): study protocol for a cluster randomised controlled trial. Trials. 2020 Nov 5;21(1):913. doi: 10.1186/s13063-020-04736-x. |